When hospice reverts to the lowest common denominator and leaders obsess about metrics, it's time to speak. Self-inflated leaders assume clinicians give until their backs break, given no raises for years. A clinical ladder is a rainbow’s pot of gold. Others have a sorrier job and must be motivated by money. Abysmal leaders dangle extrinsic rewards for admission, hiring and EDBITA targets. “Sign on” bonuses entice people into a poor work environment. Employees’ voice equals their raise, zero.

Tuesday, March 25, 2014

Gentiva revealed its 2013 executive compensation in its annual proxy statement (SEC filing). Average pay increased by 10% for senior executives from 2012 to 2013. With the addition of Executive Chairman Rod Windley total executive pay rose 66.1% to $8.5 million. I'm not sure how much joy Gentiva employees got from the $2.9 million expenditure on the Chairman of Fun.

What was the average raise for Gentiva employees during 2013? It was not in the company's annual report. I'm sure it was nowhere near 10%.

I know many who got no raise whatsoever. I know others who got the merest pittance of a raise, such that their 2013 W-2 was less than their 2012. I'll leave it to each Gentiva employee to judge their pay changes in light of our top leaders. Sad days indeed for those wanting leadership by example.

Anonymous

P.S. Gentiva's 10-K stated: "During 2013, the Company undertook a corporate restructuring initiative, referred to as "One Gentiva", to better align its home health, hospice and community care businesses under a common regional management structure. In addition, the Company undertook a branch rationalization initiative to review under performing branches. As a result of this review, the Company has closed or consolidated 77 branches through early 2014." Gentiva is synonymous with under performance, so why is executive pay higher?

Saturday, March 22, 2014

Your stories of high turnover from a bully Site Director echoed my experience with Generic Hospice. In my eleven years with the organization I've had good, great and sorry local leaders. The first four years we had very little turnover, 10% per year, maybe 15% in a bad year. The next four were very different. Turnover soared to 40% or more annually. When the company hires hands (not committed, engaged hearts/minds), it's easy to replace them with another set.

This was punctuated by a visit from corporate HR, supposedly concerned about turnover. Oddly, they didn't talk privately to anyone who'd left or were planning to leave. They didn't explore exit interviews or post-employment surveys for concerning issues. They didn't administer a confidential survey to take the pulse of our team.

HR offered employees one option, large group meetings in which to share concerns. Less than a third of our staff showed up at the group sessions. It became clear HR wasn't there to explore turnover at all. They didn't come to deeply understand current thinking at our site on a range of issues.

Their fraudulent consultation resulted in promises about supporting staff better. These did not last. Retribution needed to be made. Our bully Site Director continued their practice of identifying the few "problem people" preventing us from achieving greatness. The victims were psychologically tortured.

Fortunately, the bully's egocentricity impacted referral relationships. Corporate didn't care about their people, but they cared mightily about money. They couldn't see the damage from losing caring nurses, social workers, chaplains, volunteer coordinators, nurse aides and bereavement counselors but they could comprehend declining patient volumes.

Our ex-dedicated, caring hospice professionals turned into a local "abused alumni" association, firmly aligned against our bully Site Director. Referrals declined. The bully blamed marketers. While our staff revolving door never ended under their tormentor-ship, patients leaving would not be tolerated. It took years but corporate finally saw something they couldn't enable.

To the very end the bully remained unaware of their role in decimating our site. They didn't go away quietly, but they did eventually go away. It took years to build back what they'd destroyed.

I can't tell you how dark things were for so long. It cannot be put into words and feels absolutely awful. I expect that's where you and your hospice are at the moment. Hospice work is difficult enough without the daily machinations of bad management. Add the twisted thought patterns and cruel actions of bully managers and the work becomes nearly unbearable. I wish you and the people at your site courage, strength and peace.

Harden deal - First half of year will focus on integrating Harden. 2nd half of year before look at any acquisition activities.

OneGentiva strategy - One general management structure covering home health, hospice and community care. Ultimately have one sales force calling on a single provider for all product lines. Took out a significant amount of division, area and regional management structure as part of this (reorganization).

Becoming more of a cluster focused business throughout U.S. Harden deal gave us increased presence in Texas.

Community Care - lever to expand to other states. Believe its a significant cross referral business. Every CC patient is a future home health or hospice patient.

Cross referrals are the name of the game within Gentiva. While this may be an opportunity for the company, it's also an area of risk if underhanded methods are used to meet "hard" corporate targets.

Harden deal allows us to delever.

Fascinating. It's hard to delever when writing down assets like Gentiva did in 2013.

We've been hit very hard in the first quarter by weather.

This is a preview for future earnings calls.

We add in our equity compensation, which is about $9-10 million per year.

Washington says they prefer to have a lower number of providers in this space.

Medicare wants many things from hospice providers and things are clearly getting tougher.

We've had some rocky years. In this industry there's been a negative environment that's been out there in both the home health and hospice. We all hope that will subside over time and we'll get back to focusing on the patient need, patient care and the industry will start to climb again.

Wednesday, March 5, 2014

I apologize for sending you so much stuff on Gentiva lately, but I appreciate your posting it on Generic Hospice. I know the for-profit business side of hospice drives you crazy, as it does most longtime hospice professionals. The picture above shows the stock market's reaction to Gentiva's earnings call. It did not inspire confidence outside the company, which remains a black hole for Senior Executive messages.

Anyway, a longtime nurse said Gentiva's stock price the last few years reminds her of her experience working for PhyCor. That ended very badly after the last round of health reform reconfigured the landscape pre-Y2K.

Here's to more posts from you about inspiring leaders at Generic, given Gentiva's are incapable of such. Our Branch Manager did extra scurrying around the last two days. Their projects feel like rearranging the deck chairs on the Titanic.

Tuesday, March 4, 2014

Gentiva surprised with poor earnings and a huge asset write down for the 4th quarter. Wall Street analysts must be tired of hearing promises from CEO Tony Strange, especially in the hospice arena.

If Gentiva's corporate chiefs couldn't understand hospice as a single division, how will they gain a greater understanding by placing hospice with home health and community care? Add that Area Vice Presidents saw the number of sites they support doubling or tripling under OneGentiva and the learning curve steepens.

1. Why is our site losing good, caring, talented hospice nurses by the carload?
2. Why aren't nurses beating at our doors to work with the best hospice physicians in town (by far)?
3. Why is staff leaving our hospice to work for other nearby hospices, when they used to leave hospice altogether?
4. What impact does our obscene level of turnover have on patients, families and referral sources?
5. How do staff, the people providing the care, feel about the support they receive from above, site level and corporate?
6. How do our hospice physicians feel about high nursing turnover and their endless job of helping to train new hospice nurses (with the good ones lasting but a year)?
7. Why do talented, caring staff continue to work hard despite miniscule salary increases and a 40 hour cut in PTO accrual at each step?
8. How many ways and in what manner has corporate cut the quality of our hospice service via top down edicts in the last three years?
9. What, if anything, has corporate actually done to be the employer of choice for hospice in our community? How many ways and in what manner has corporate ensured our site is not the hospice employer of choice locally?
10. How many times does corporate plan to take away over a decade of brand recognition with yet another name change?
11. Why does communication only go one way in this company, top down?

Answers to these questions, properly heard, could be transformational. Here's the only measure I believe corporate uses to evaluate our site: Are you meeting budget and EBDITA targets? If not, CEO Tony Strange spoke of the consequence:

While the elimination of jobs and the abandoning of underserved markets
has always been painful for organization, we enter 2014 much better aligned
across our platform with the added value of an improved cost structure
to help offset some of the impact of the rate cuts.

Anything else is fluff, window dressing, stuff Gentiva executives say to sound like regular human beings, like the hearty thanks to employees at the end of Strange's prepared remarks.

In closing, I want to thank all of our employees for the compassion that you bring to our patient's home each and every day.

How many employees' received a 2013 W-2 that was less than their 2012? I'd venture those employees don't feel the least bit appreciated by the company.

Saturday, March 1, 2014

How's turnover at Generic Hospice? The first two months of the year we lost a bereavement counselor, chaplain, receptionist, five nurses and a pet therapy dog. All left due to our Branch Manager's bullying. How bad does a manager have to be when the pet therapy dog gets their hackles up?

Anyway, it was the oddest thing. The Branch Manager started in their hypercritical mode. Staff closest to the BM wilted, while those within earshot scattered to the hinterlands. The BM zeroed in on the Bereavement Coordinator.

"Why didn't you call this person?"--BM
"I did."--BC
"Why didn't your reach them?"--BM
"They didn't answer, so I left a message."--BC
"Did you go by the house?"--BM
"No."--BC
"I told you to contact this person ASAP."--BM
"Yes, you did and I did that."--BC
"NO, YOU DID NOT!"--BM (with spit flying from their mouth)
"Grrrrrrrrrr. Bark, Bark, Bark"--Pickles the pet therapy dog
"YOU WANT A PIECE OF ME!"--BM glaring at the dog and the BC
"Frankly, I'd rather have none of you. I quit."--BC
"YOU CAN'T LEAVE UNTIL I'M DONE WITH YOU!"--BM
"Watch me. Let's go, Pickles."--BC
"OFFICE MANAGER! OFFICE MANAGER!!!"--BM
"Yessa, Boss. How may I hep?"--Office Manager
"ESCORT THEM OUT!"--BM
"I believes theys already gone."--OM
"MAKE SURE THEY LEAVE THE PARKING LOT!"--BM

(in the parking lot)
"Whimper, whimper."--Pickles the pet therapy dog
"Bullying does leave a mark. However, it's nice we have one another"--BC as he pets Pickles
"Slurp, slurp."--Pickles licks BC's face

(Office Manager scampers up)
"Boss seys youse two needs to run along now."--OM
"What are you going to do to stop the abuse?"--BC
"Abuse. I don't see no abuse. Our site has a grate leader."--OM looking over shoulder
"I find the BM very grating. We'll soak up a little sun and then move on."--BC
"Don't stays too long. Bossa blame me and then I gets a beating."--OM whispering

Our site's stew is a foul mix. Our Branch Manager needs to sink in their own offal, the cyclical turnover mess they've created for years. Despite being told repeatedly by departing staff that they are the cause, our Branch Manager deflects that away to anyone and everyone else. The few remaining left know the tremendous harm our BM causes to staff, therefore to our patients.

After firing the pet therapy dog the BM continued rearranging the deck chairs on our Titanic, by asking each staff member what color they wanted their office painted and what day of the weekend they would be coming in to do the work. Of course, this would all occur under the BM's impressive supervision and would not be paid, but be volunteer. Also the event is BYOP, bring your own paint.